Erythrodermic psoriasis presenting with generalized scaling and erythema

A middle-aged male presented with a history of progressive generalized redness and scaling of the skin for several months, associated with severe pruritus and discomfort. The condition initially started as localized scaly plaques over the extremities and gradually progressed to involve almost the entire body surface. There was no significant drug history or known systemic illness. On examination, there was diffuse erythema involving more than 90% of the body surface area, with extensive exfoliation and thick scaling over the trunk and bilateral upper limbs. The skin appeared dry, inflamed, and lichenified in some areas. No mucosal involvement was noted. Laboratory investigations revealed mild leukocytosis with no other significant abnormalities. Based on clinical findings, a diagnosis of erythrodermic psoriasis was made. The patient was managed with systemic methotrexate (15 mg/week) along with folic acid supplementation, intensive emollient therapy, antihistamines, and supportive care including fluid and electrolyte management, resulting in gradual clinical improvement over 8-10 weeks.